PATENT APPLICATION FEE DETERMINATION RECORD
Effective October 1 , 2003
CLAIMS AS FILED - PART I
(Column 1) (Column 2)
TOTAL CLAIMS
FOR
TOTAL CHARGEABLE CLAIMS
INDEPENDENT CLAIMS
3
NUMBER FILED
minus 20=
minus 3 =
NUMBER EXTRA
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED • PART II
(Column 1)
(Column 2)
(Column 3)
ENT A I
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
S
o
z
Total
*
Minus
**
a
UI
s
Independent
tfinus
***
3
<
FIRST PRESENTA"
rtBWOF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Column 3)
ENTB [
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
a
z
Total
*
Minus
4*
UJ
2
Independent
*
Minus
**#
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
, ,□
(Column 1)
(Column 2)
(Column 3)
ENTC
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
s
Q
Z
Total
*
Minus
«*
s
UJ
2
Independent
Minus
***
m
< "
FIRST PRESENTATION OF MULTIPLE OEPENDENT CLAIM
□
SMALL ENTITY OTHER THAN
TYPE CZI OR SMALL ENTITY
* If me entry in column 1 is less than the ntry m column 2. write *0" In column 3.
"If the 'Highest Number Previously Paid For* IN THIS SPACE is less than 20. enter "20/
~H the 'Highest Number Previously Paid For* IN THIS SPACE is less than 3. enter *$ '
The 'Highest Number Previously Paid For" (Total or Independent) is trie highest number found in the appropriate box in column 1.
RATE
FEE
RATE
FEE
BASIC FE
E 385.00
OR
BASIC FEE
770.00
XS9=
OR
X$18=
X43=
OR
X86=
♦145=
OR
+290=
TOTAL
m
OR
TOTAL
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
XS 9=
OR
XS18=
X43=
OR
X86=
♦145=
OR
+290=
TOTAL
ADDIT. FEE
OR
TOTAL
ADDIT. FEE
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X43=
OR
X8€=
♦145=
OR
♦290s
*
TOTAL
ADDIT. FEE
OR TOTAL
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$9=
OR
X$18=
X43«
DR
X86-
+145=
3R
+290»
TOTAL
•
nB TOTAL
ADDfT. FEE
FORM PTO-873 (Rev. 10/03)
Pafom and Trademattc OfSce. g.S DEPARTMENT OF COMMERCE